Utility of Eye-Symptom Provocation in Assessment of Adolescent Concussion

Abstract

Purpose : Studies have shown that >50% of patients with persistent concussion symptoms have deficits in vergence and accommodation. Clinicians often report that patients show physical discomfort or aversion on vision assessments. Symptom provocation for headache, nausea, fogginess, and dizziness are commonly elicited using the Vestibular Oculomotor Screening (VOMS), a sensitive tool in evaluating concussed patients. However, these symptoms do not explicitly assess vision symptoms. Our study explored if eye-symptom provocation aids understanding of the involvement of these systems in concussion.

Methods : 34 concussed (73% female; mean age 15 years, range: 8-18; mean days since concussion:106, range: 36-273) and 30 non-concussed controls (56% female; mean age 13 years, range: 10-17) were recruited. Comprehensive eye examination included near point of convergence (NPC), fusional vergence ranges, vergence facility, amplitude of accommodation (AA), and accommodative facility. Eye-symptom provocation was assessed on a scale of 0 [none] to 10 [severe] for eye strain, eye discomfort, and eye pressure after each clinical measure. Group and proportional differences were determined using Mann-Whitney U and Chi-square tests, respectively. Abnormal values on total eye-symptom provocation were defined as below the 95^th percentile in controls.

Results : Total eye-symptoms provocation on NPC, fusional vergence ranges, vergence facility, AA, and accommodative facility were significantly higher in the concussed group (U=888.0, 904.5, 852.5, 897.0, 910.0, respectively; all p<0.001). Chi-square analyses showed significant relationships between eye-symptom provocation and passed/failed NPC (X²=9.09, p<0.01), or AA (X²= 19.231, p<0.001). In participants with normal NPC (n=34) or AA (n=31), most reported no eye-symptom provocation (NPC: 85%; AA: 84%). In those with abnormal NPC (n=24) or AA (n=27), eye-symptom provocation was often reported (NPC: 50%; AA: 70%). However, a notable number of participants with abnormal NPC (50%) or AA (30%) did not report symptoms; similarly, several with normal NPC (15%) or AA (16%) did report symptoms.

Conclusions : Eye-symptom provocation could be a useful tool in identifying concussion. Increased eye-symptom provocation may not indicate presence of abnormal vergence and/or accommodative system yet eye-symptom provocation does identify patients who experience heightened symptoms on vergence and accommodative effort.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.